AR
TICLE
Neoliberal meritocracy and financial capitalism:
consequences for social protection and health
Abstract There is inherent tension between the idea of health as a social right and of health as a private good. From the latter perspective, heal-thcare provision is brought closer to the logic of ownership, where access depends on ability to pay. The prioritization of markets (over governments), economic incentives (over social or cultural nor-ms), and entrepreneurship (over collective or community action), one of the hallmarks of ne-oliberalism, constitutes a project to dismantle the welfare state, defined as a set of policy mechanis-ms designed to meet collective needs. This article examines the above process and its consequences for social protection and health by reflecting upon two phenomena that threaten the principle of he-alth as a social right: neoliberal ideas and policies; and financial capitalism. We argue that the com-mon good must be defended or insulated from the negative effects of financial capitalism and from the erosion and fragmentation of public institu-tions and social protection systems caused by ne-oliberalism.
Key words Capitalism, Commodification, Public policy, Public health
Ana Luiza d’Ávila Viana 1
Hudson Pacifico da Silva 2
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ALd’A, Introduction
Ten years after the publication of the article en-titled Economia política da saúde: introduzindo o debate (Political economy of health: introduc-ing the debate)1, written by the authors of the
present article and professor Paulo Elias, there are obvious tensions between healthcare under-stood as a right and collective (or public) good and healthcare as a private good in the wake of the rapid global advance of the commodification of both funding and provision of healthcare ser-vices. These tensions – over healthcare services, which are increasingly delivered by multination-al corporations with business activities in various sectors and dependent on the financial cycle, and over funding, given that individuals are having to take increasing responsibility for ensuring they have access to health actions and services – are being transformed into antagonism and threat.
In the abovementioned article, we talked ex-actly about the tensions inherent in the idea of health as a right and universal collective/public good and health as a private good. From the lat-ter perspective, health service provision is brought closer to the logic of ownership and funding ceases to be a collective responsibility in the form of gen-eral taxation, becoming dependent upon ability to pay, without solidarity between different segments of society – the healthy and the sick, the rich and the poor, the young and the old. As highlighted by the World Health Organization (WHO), out-of-pocket payments (OPP) are the least equitable way to finance health systems and one of the ma-jor causes of impoverishment, particularly in low and middle-income countries, where OPP remain the primary source of funding2.
This amounts to an abrogation of the collec-tive responsibility for health, whereby responsi-bility for individual health and risk is left solely with the individual and access to health services is held hostage to the numerous purchasing mechanisms (paying up front, installments, and individual and group payment schemes), accord-ing to individual and family income, in a con-fusing mosaic of individual and collective forms, both belonging to the market cycle.
The entrepreneurization of public sector healthcare provision3 and financialization and
internationalization of healthcare (health insur-ance companies, health plan operators and ser-vice providers)4,5 are a major move away from the
provision of free health services as a public good (in the case of national health systems) and social security as a public policy (in the case of
contrib-utory health systems) towards ownership-indi-vidual, production-rentier logic (market-based health systems).
According to Robert Castel6, the notion of
so-cial ownership, the bedrock of freedom and back-bone of liberal ideas, counter poses individual ownership by guaranteeing non owners freedom and autonomy through a public service appara-tus, allowing them to live without future hard-ships. Thus, the welfare state may be defined as a set of devices that aim to meet collective needs using bases other than the market. Therefore, dismantling the welfare state represents a huge step backward from the provision of healthcare as a collective or public good towards the provi-sion of health services as private goods adopting an ownership-based approach.
To examine how this process came about, it is necessary to reflect upon two phenomena that were major blows to provision of health as collective good: i) neoliberal ideas and policies in the form of specific economic policies (neo-liberal economic policy prescriptions that revere the market and competition) and a shift in ra-tionale away from cooperation towards compe-tition and individualism; and ii) the financializa-tion of wealth, leading to the deep imbricafinancializa-tion of the business/economic facets of the social arena (housing, health, infrastructure, education, social welfare, etc.) and the national and global finan-cial system, whereby investment decisions are subordinated to the imperatives of the valuation of financial assets on the different markets.
This article is divided into four parts. In the first, we discuss the consequences of neoliberal-ism for the organization of capitalist societies, drawing on recent studies by economists who propose a critique of dominant and hegemonic neoliberal ideology and policies. In the second part, we outline the main features of financializa-tion and its consequences in the social arena. We then go on to retrace the origins of neoliberalism, providing a critique of American liberalism, and review the interpretations of certain authors as to its impact on the life of the average person stem-ming from the creation of a neoliberal meritoc-racy. Finally, we discuss the extent to which this process has influenced social protection, focusing on health.
Neoliberalism is much more than an economic policy
According to Rodrik7, in broad terms,
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governments), economic incentives (over social or cultural norms), and entrepreneurship (over collective or community action). Though used to describe a broad set of phenomena – from Au-gusto Pinochet to Margaret Thatcher and Ron-ald Reagan, the Clinton Democrats and United Kingdom’s New Labour to the opening up of the Chinese economy and reform of the Welfare State in Sweden – the term “neoliberal” gained visibility in the 1990s, when is became associated with two clearer manifestations: i) financializa-tion and financial deregulafinancializa-tion, culminating in the crisis of 2008; and ii) economic globalization, accelerated by the free flow of money and new international trade agreements. Indeed, it is dif-ficult to deny that most of the world experienced a decisive shift towards markets beginning in the 1980s and that even center-left governments be-gan to enthusiastically adopt some of the guiding principles of neoliberalism, such as deregulation, privatization, financial liberalization, and entre-preneurism.
According to economists who engage in crit-ical thinking, including winners of the Nobel Prize for Economics (Paul Krugman, Joseph Sti-glitz and Amartya Sen), neoliberalism and its ha-bitual remedies (more market, less government) are in fact a perversion of conventional econom-ics, in so far as the contribution of neoliberal economists to the public debate is frequently biased in the same direction: more trade, more finances, and less government. That is why neo-liberal economists have gained a reputation for being the ‘cheer leaders’ of neoliberalism, despite conventional economics being far from an un-conditional defense of laissez-faire. As the critical line of thinking asserts, economists who let their enthusiasm for the free market run wild are not being true to their discipline7.
The key question to understanding this phe-nomenon, which began with an identification with economics and has broadened its horizons to become a reason for the world is: how did this happen? In recent decades, the word neoliberal and its associated concepts and meanings have taken over research, reflections, public policy and government, and corporate and individual action. As Dardot and Laval correctly asserts8,
neoliberalism goes beyond an economic policy and ideology, becoming the raison d’être of con-temporary capitalism, a new mindset.
Illustrating some of the most important an-alytical perspectives of recent years, comprehen-sively reviewed by Cahill and Konings9, world
literature on the topic has portrayed
neoliberal-ism as an ideology, economic policy, a hegemonic political coalition, the policy of the elite, conser-vatism, a new form of imperialism, and the rea-son for the world. However, a common thread to these perspectives is the view of neoliberalism as an ideology that is based on a straightforward opposition between state and market, represent-ed by the events that lrepresent-ed up to the financial crisis of 2008, demonstrating the deep imbrication of state and private finance. That is why several au-thors view neoliberalism (also) as a new rationale for government intervention that overcomes the old vision that suggests there is a fundamental conflict between state and market.
It amounts to a contemporary capitalist mode of existence, characterized by the hijacking of the state by market and financial forces. The nexus between the state and finance is currently the central nervous system of the accumulation of capital. As Saad-Filho10 asserts, neoliberalism
is not only a movement to restore classical liber-alism and promote the affirmation of the elite. In some cases, it goes beyond a conservative alliance and manifests itself as a new type of imperialism.
The role of large corporations has evolved considerably, with a significant expansion of their sphere of operations to include an array of different goods and increased engagement in the provision of social services in the wake of pol-icies to promote privatization and commodifi-cation and industry and financial deregulation. Such policies favor the free movement of capital, allowing it to play a dominant role in the global economy and our lives, greater tolerance towards unemployment resulting from a new vision of macroeconomic policy oriented towards con-trolling inflation and fiscal austerity, and trade union disputes. These factors have led to the cre-ation of a new institutional architecture for the management of capitalism and its relationship with the social sphere at both local and interna-tional level.
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ALd’A, Thus, the decline in public social service
provision together with the deep imbrication of social protection systems and the economy, with neoliberal restructuring of capitalism, has led to a shift from the protection of rights and public provision towards the commodification of so-cial protection through private provision paid by citizens. The ultimate result is the neoliberal hy-bridization of the public and private sector, that is, a blurring of the boundaries between public and private and commodification of the public sphere, which is forced to play by the rules tradi-tionally employed in the private sector, where the logic of competition and profit dominates.
As various recent studies and publications have shown11-15, the consequences of
neoliber-alism are distributed across various dimensions (Chart 1). Changes in state-market-society re-lations are marked by the weakening of the po-litical forces that defend the welfare state that developed throughout the twentieth century. Economic growth is reduced and appropriat-ed by the profiteers – those who live on income earned mainly on the financial markets, while society becomes increasingly alien and incapable of forming coalitions to defend its rights, turn-ing its attention to external phenomena (such as immigration and the resulting intensification of competition in the labor market). Social protec-tion is reduced or targeted at those who are able to pay, who are generally workers working in the formal sector. The consequences for the well-be-ing of individuals are numerous, with an increase in the prevalence of various diseases and mental disorders.
The welfare state, neoliberalism and financialization of social protection
The creation and development of the welfare state – that is, a national system of decommod-ified social service provision, based on the cre-ation of social funds maintained by the collection
of taxes and social security contributions, where it falls upon the state to protect the population against the major risks that threaten individu-als in contemporary societies (accidents, illness, aging, death, unemployment, social exclusion) – occurred in a specific moment in history (1945-75) marked by the positive conjunction between economic growth and the reduction of social inequalities16. During this period, various
coun-tries adopted active political policies designed to promote economic growth, either through the implementation of monetary, fiscal and exchange rate policies, or direct public investment. At the same time, the role played by unions and adop-tion of labor protecadop-tion policies also contributed to real wage growth and the introduction of var-ious worker benefits. These factors made it pos-sible to conciliate accelerated economic growth with a more equal distribution of the wealth gen-erated.
However, the economic crisis experienced in the last quarter of the twentieth century led many to severely question the model, paving the way for the strengthening of neoliberal policies in the majority of both core and peripheral Western countries. As mentioned in the previous section, these policies were based on a (re)valuation of free market society ideology, through the adoption of a set of market-oriented reforms, including the end of state economic planning, privatization of state-owned enterprises and public services, de-regulation of the financial and labor markets, tax reduction, and the free flow of goods and capital. With respect to social protection, neoliberal poli-cies emphasized self-funding of access to services (with an effective increase in the contribution of service users to social expenditure), actions fo-cused on the poorer segments of society, decen-tralization of service provision and management, separation of functions (funding and provision, for example), and competition between different service providers (schools, hospitals, etc.). Thus, there has been a major break with strong
govern-Chart 1. The consequences of neoliberalism for society, the economy, politics, social protection and health status.
Dimension Consequences
Society More individualistic, materialistic and socially antagonistic
The economy Slower economic growth, greater concentration of income, greater financial insecurity Politics Middle and lower classeshave less political power
Social protection Children, adults and the elderly do not have adequate social protection
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ment involvement in the social arena, due to a series of common (and also specific) factors that have influenced all public social service provision systems.
It has always been difficult to identify the sim-ilarities between the social protection systems, programs, areas of social protection, timing and circumstances of different countries. However, as Fine17 points out, this does not mean that
mod-ern social protection systems are free of common influences. Globalization and neoliberalism, on the one hand, and financialization of wealth on the other, have imposed a series of limits, con-tradictions and new forms of expanding social protection, be it via the state or market.
Globalization was a central element of the constraints faced by the welfare state because social spending burdened locally manufactured products and created barriers to competition on the world market. Several countries reformed their social protection systems to increase com-petition. The following examples illustrate this dilemma: Italy lost competitiveness due to the labor spending burden; France opted to reform its welfare state; while Germany may be regarded as an excellent example, since its social securi-ty-based system associates lower costs with great-er labor productivity.
According to Fine17, strengthening private
consumption extinguished or created major ten-sions for so-called long periods of public system provision (the other side of collective consump-tion), since the public service provision system is not a consumer goods market, but rather a specific arrangement to satisfy need. Financial-ization fiercely attacked the social policy sys-tem when the financial sphere turned the logic of accumulation much more oriented towards speculation, the unlimited expansion of credit, the penetration of private finance into the so-cial and economic arena (in areas such as health, education, social security, social infrastructure, and housing), and the emergence of a neoliberal culture that revered the private goods market as much as it did anti-statism.
In the past, development and universal social policies were elements of a pattern of industrial accumulation in which productivity gains were transmitted into wage growth, whose purchasing power guaranteed increased demand for manu-factured goods because social protection systems decommodified access to social goods and ser-vices, resulting in more available income to drive growth in private consumption though the pur-chase of manufactured goods17. Public funding
via taxation allowed for the socialization of risks, resulting in the need for an ideological discourse based on solidarity and social justice. The public sector ethos sealed this alliance endorsed by ma-jor corporations and unions in a democratic en-vironment, secured by wide-ranging agreements between workers and employers.
Today, the expansion of private consumption no longer depends on the decommodification of access to social goods and services, since the con-sumer credit system, with all its different mecha-nisms (credit cards, overdraft, loans etc.), is able to play this role. The solidarity-based public sec-tor ethos has been broken by the fragmentation of social life and the labor market, whereby peo-ple are constantly changing places and positions in a system in which flexibility (agility, openness to short-term change, capacity to take risks, etc.) is an essential element18. It is also possible to
ob-serve the expansion of privatization and private consumption of social services, due to growing supply, the valuation of life styles based on com-petitive individualism, and the defense of indi-vidual diagnoses and treatments, corroborated by scientific advances and the desire for individ-ualization.
There is also a deep imbrication of the busi-ness/economic facets of the social arena (hous-ing, health, infrastructure, and education) and the national and global financial system, whereby investment decisions are subordinated to the im-peratives of the valuation of financial assets on the different markets. In the healthcare field, the strategies of major business groups are evident in the move towards mergers and acquisitions on a global scale leveraged by major financial groups. According to Hiratuka et al.5, the number of
mergers and acquisitions increased from 39 in 1999 to 432 in 2013, with values ranging between US$10 and 20 billion.
Although the move towards mergers and acquisitions is stronger in core countries, where the association between investment funds and healthcare companies has contributed to the rapid concentration and internationalization of markets, this phenomenon can also be seen in developing countries. In Brazil for example, according to Hiratuka et al.5, around 60 merger
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by foreign companies (United Health and Bain Capital, respectively). As can be seen in Chart 2, 12 of Brazil’s 20 largest companies in the Brazil-ian health services sector are health insurance companies or health plan operators, including the three largest. It is important to highlight that the business activities of the large majority of these companies, which are financial interme-diaries, include also service provision, given that they possess their own network of hospitals and other healthcare facilities.
Studies on the topic of financialization19,20
have shown that a new business management model more aligned with the interests of share-holders currently dominates in large companies. This new model includes two key dimensions: on the one hand, the classical view of a compa-ny as a coherent and integrated combination of permanent assets in pursuit of innovation and long-term growth has been replaced by a finan-cial conception in which a company is viewed as a portfolio of liquid subunits that should be continually restructured to maximize share val-ue; while on the other, management compensa-tion is no longer linked to long-term company success, but rather short-term movements in the share market, meaning that the interests of up-per management are aligned with the interests of investors and those who hold the majority of the company’s capital. Thus, scaling up and inte-gration of international operations are strategies used for reducing costs and increasing short-term profitability. The global centralization of capital and the formation of large international conglomerates are the result of this process5.
Who are the neoliberals and what are its consequences for the average individual? The neoliberal meritocracy
Who are the neoliberals? To explain the his-tory of the constitution of this new way of orga-nizing the world, we need to go back to the be-ginning of the 1980s. Published in 1982, Charles Peters’ “A Neo-Liberal’s Manifesto”21 refers to
neoliberalism as an embryonic movement that brought together politicians, journalists and economists eager to take a critical look at the objectives and values of liberalism. They claimed that traditional liberal responses aggravated the problems that began to emerge in the 1970s: declining productivity; decaying infrastructure; inefficient and unaccountable public agencies; a military with weapons that didn’t work and few
people from the upper classes in its ranks; and the explosion of political action committees de-voted to the interests of single groups, among others. Thus, according to Peters, neoliberals are liberals who have reviewed ideas that previously favored unions and big government and opposed the military and big business. In other words, they started to defend the latter over and above the former.
The central concerns of this pioneering group of neoliberals were the community, democra-cy and prosperity, of which economic growth is now the most important. Their hero was the risk-taking entrepreneur who creates new jobs and better products. According to Peters, public policy should encourage productive investment. On the other hand, the neoliberals were opposed to: economic regulation that discourages healthy competition (except for the regulation of health and safety); unions that demand wage increases without a corresponding increase in productiv-ity; management compensation that encour-ages short-term profit as opposed to long-term growth (but favorable towards giving workers a share in the ownership of the company); a “fat, sloppy, and smug” bureaucracy (but favorable to-wards meritocracy/performance standards in the public sector). Thus, the neoliberal movement considered itself to be pragmatic and idealistic, focusing for example on making education bet-ter, ensuring social benefits target those in real need, and the adoption of compulsory military service.
As Peters’ manifesto asserts, the meaning of neoliberalism has changed considerably over time as the label began to carry strong connotations of deregulation, financialization and globalization. This idealistic way of looking at the world ceased to exist in the command of neoliberal policy and today defenders of this policy hide behind its more altruistic values typified by Peters’ mani-festo, apparently forgetting the recent course of events outlined in the first part of this article. However, it is exactly this vision of neoliberalism that is disseminated by the mainstream media, particularly in emerging economies, and which constitutes the narrative of the common sense of neoliberalism, dramatically influencing a large proportion of the world’s population, above all the middle classes.
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of thinking has developed and shaped individu-al attitudes over the last 40 years. These authors describe a common desire to strive for perfection classified into three dimensions of perfection-ism: self-oriented perfectionism (where individ-uals hold unrealistic expectations of themselves); other-oriented perfectionism (where individu-als hold unrealistic expectations of others); and socially prescribed perfectionism, considered the most debilitating of the three dimensions of perfectionism, since it describes the feeling of paranoia and anxiety engendered by the per-sistent sensation that everyone is waiting for you to make a mistake.
The results of the study showed that people born in the United States, United Kingdom and Canada after 1989 obtained higher scores than previous generations for all three dimensions of perfectionism and that scores showed linear in-creases over time. However, the most dramatic change occurred with socially prescribed per-fectionism. How can this be explained if we do not resort to the idea that the development of perfectionism is influenced by broader cultural norms? According to the authors, three inter-re-lated cultural changes influenced these changes:
(a) the emergence of neoliberalism and compet-itive individualism; (b) the rise of the doctrine of meritocracy; and (c) increasingly anxious and controlling parental practices. As pointed out by Day:
Since the mid-1970s, neoliberal political-eco-nomic regimes have systematically replaced things like public ownership and collective bar-gaining with deregulation and privatization, pro-moting the individual over the group in the very fabric of society. Meanwhile, meritocracy — the idea that social and professional status are the di-rect outcomes of individual intelligence, virtue, and hard work — convinces isolated individuals that failure to ascend is a sign of inherent worth-lessness. Neoliberal meritocracy (…) has created a cutthroat environment in which every person is their own ambassador, the sole spokesman for their product and broker of their own labor, in an endless sea of competition. As Curran and Hall observe, this state of affairs “places a strong need to strive, perform, and achieve at the center of modern life,” far more so than in previous gen-erations (…) Neoliberal ideology reveres compe-tition, discourages cooperation, promotes ambi-tion, and tethers personal worth to professional Chart 2. Net revenue (R$ million) of the 20 largest companies in the Brazilian health care industry in 2016.
Company Net revenue Activity
1. Bradesco Saúde 18,273.1 Health Insurance
2. Amil 16,765.2 Health Plans
3. Sul América Saúde 12,091.4 Health Insurance
4. Rede D’Or São Luiz 7,912.5 Medical Services
5. Unimed Rio 5,040.3 Health Plans
6. Hospital São Paulo 4,777.8 Medical Services
7. Central Nacional Unimed 3,922.4 Health Plans
8. Grupo Notre Dame Intermédica 3,894.2 Health Plans
9. Unimed Belo Horizonte 3,057.4 Health Plans
10. Dasa – Diagnósticos da América 3,040.8 Medical Services
11. Hapvida 3,036.5 Health Plans
12. Hospital Albert Einstein 2,520.0 Medical Services
13. Hospital e Maternidade São Camilo 2,326.7 Medical Services
14. Fundação do ABC 2,249.2 Medical Services
15. Unimed FESP 2,208.8 Health Plans
16. Santa Catarina 2,144.0 Medical Services
17. Fleury Medicina e Saúde 2,096.1 Medical Services
18. Unimed Saúde 1,972.6 Health Insurance
19. Esho 1,968.5 Medical Services
20. Unimed Porto Alegre 1,947.8 Health Plans
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make people much more critical of others and anxious about being judged.
Curran and Hill suggest that the cultures of the countries studied “have become more indi-vidualistic, materialistic, and socially antago-nistic over this period, with young people now facing more competitive environments, more unrealistic expectations, and more anxious and controlling parents than generations before”. One of the consequences of increased perfectionism has been a series of epidemics of serious mental illness: perfectionism is strongly correlated with anxiety, eating disorders, depression and suicidal thinking. Furthermore, another consequence of the increase in perfectionism is that it jeopardizes the development of solidarity.
The above analysis concurs with the work of Verhaeghe15, who holds that meritocratic
neo-liberalism favors certain personality traits and penalizes others: articulateness, to win over as many people as possible, flexibility and willing-ness to take risks are necessary characteristics for a successful career. Verhaeghe contends that, on the other hand, “Solidarity becomes an expensive luxury and makes way for temporary alliances, the main preoccupation always being to extract more profit from the situation… Social ties with colleagues weaken, as does emotional commit-ment to the enterprise or organization… There is a buried sense of fear, ranging from performance anxiety to a broader social fear of the threatening other.”
Effects on social protection
What is the ultimate outcome of this intricate process for social protection? Table 3 below, elab-orated using data from the latest report produced by the International Labour Organization11,
pro-vides an overview of the current state of social protection around the globe (Chart 3). It can be seen over half of the global population have no protection at all. Furthermore, the report shows that lack of coverage is greatest exactly in the re-gions where the need is greatest and that the most vulnerable groups (children and the elderly) are the least protected due to a low level of coverage among children aged between zero and 14 years and the low value of retirement benefits, which
prevents the elderly from being lifted above the poverty line.
The figures provided by the ILO leave no doubt that fiscal austerity policies, broadly in-spired by neoliberal prescriptions and imple-mented in virtually all regions of the world, have had a negative impact on social protection programs, especially those directed at children. Spending on unemployment benefits as a pro-portion of Gross Domestic Product (GDP) is tiny, exactly during unemployment crises, while the level of protection for occupational accidents and disease is low.
With respect to health, despite an extension of universal coverage, major deficits remain, par-ticularly in rural areas and among the world’s poor population, as is the case with African coun-tries. It is estimated that an additional 10 million health professionals are needed to achieve uni-versal health coverage. It is also important to note that major regional disparities exist even within developed countries. Finally, meeting the health needs arising from epidemiological shifts (in-creasing burden of chronic diseases that require long-term care) remains a challenge for many public health systems.
Conclusions
The overview of social protection around the globe demonstrates that there are major gaps throughout the entire life cycle, which cause more illness, poverty and death. Few intellectuals under-stand how financial capital interests and neoliber-al policies place a large proportion of the world’s population in a situation of risk, while the issues discussed here receive very little media coverage.
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Chart 3. Overview of social protection around the globe (2017).
General Children Working-age
Population Older persons Health
. 55% of the world’s population (around 4 billion people) is not covered by any social protection benefit
. 71% of the world’s population is not protected by social protection systems that include a wide range of benefits . Coverage problems are associated with low levels of investment in social protection, especially in regions of Africa, Asia and Arab States . Lack of social protection makes people more vulnerable to poverty, inequality and social exclusion throughout the life cycle, constituting a major obstacle to social and economic development . The Sustainable Development Goals (SDG) call for universal social protection and countries have the responsibility to guarantee at least a basic level of social security (a social protection floor) for all as part of their social protection systems
. 65% of the world’s children do not have access to social protection, most of them living in Africa and Asia
. On average 1.1% of GDP is spent on child benefit for children aged between 0 and 14 years, pointing to significant underinvestment in children, which affects not only the children’s overall well-being and long-term development, but also the future economic and social development of the countries they live in. . There has been an expansion of income transfer schemes targeting children in lower and middle-income countries in recent years. However, coverage and benefit levels remain insufficient . Many countries have reduced social protection for children in the wake of fiscal consolidation policies often narrow-targeting child benefits to the poor and leaving many vulnerable children without adequate protection
. 41% of women with newborn children receive some type of maternity benefit . 21.8% of unemployed workers are covered by unemployment benefit
. Only a minority of the global labor force have effective access to employment injury protection . 27.8% of persons with severe disabilities worldwide receive a disability benefit. . Worldwide only 3.2 % of GDP is spent on public social protection to ensure income security for persons of working age . Although there has been an expansion in coverage of maternity and work accident benefit in some countries, there are significant gaps in coverage and adequacy in others
. Many countries have reduced social protection for persons of working age as part of austerity policies at a time when social protection is most needed.
. 68% of people above retirement age receive a pension, which is associated with the expansion of both non-contributory and contributory pensions in many middle and low-income countries. . A number of developing countries have achieved universal pension coverage, while others are close to universal coverage . However, benefit levels are often low and not sufficient to push older persons out of poverty . Expenditures on pensions and other benefits for older persons account for 6.9% of GDP on average, with large variations across regions. . Fiscal austerity policies in many countries continue to jeopardize the long-term adequacy of pensions . There is a tendency to return to public solidarity-based systems in some countries because privatization initiatives have not delivered the expected results
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Article submitted 27/02/2018 Approved 12/03/2018
Final version submitted 23/03/2018
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